当前位置： SCI文献检索 > BMC INFECTIOUS DISEASES期刊下所有文献 > Impact of mass-screening on tuberculosis incidence in a prospective cohort of Brazilian prisoners.

Impact of mass-screening on tuberculosis incidence in a prospective cohort of Brazilian prisoners.

Abstract：

BACKGROUND:Globally, prison inmates are a high-risk population for tuberculosis (TB), but the specific drivers of disease and impact of mass screening interventions are poorly understood. METHODS:We performed a prospective cohort study to characterize the incidence and risk factors for tuberculosis infection and disease in 12 Brazilian prisons, and to investigate the effect of mass screening on subsequent disease risk. After recruiting a stratified random sample of inmates, we administered a questionnaire to ascertain symptoms and potential risk factors for tuberculosis; performed tuberculin skin testing (TST); collected sera for HIV testing; and obtained two sputum samples for smear microscopy and culture, from participants reporting a cough of any duration. We repeated the questionnaire and all tests for inmates who remained incarcerated after 1 year. TST conversion was defined as TST ≥10 mm and an induration increase of at least 6 mm in an individual with a baseline TST <10 mm. Cox proportional hazard models were performed to identify risk factors associated with active TB. To evaluate the impact of screening on subsequent risk of disease, we compared TB notifications over one year among individuals randomized to screening for active TB with those not randomized to screening. RESULTS:Among 3,771 inmates recruited, 3,380 (89.6 %) were enrolled in the study, and 1,422 remained incarcerated after one year. Among 1,350 inmates (94.9 %) with paired TSTs at baseline and one-year follow-up, 25.7 % (272/1060) converted to positive. Among those incarcerated for the year, 10 (0.7 %) had TB at baseline and 25 (1.8 %) were diagnosed with TB over the subsequent year. Cases identified through active screening were less likely to be smear-positive than passively detected cases (10.0 % vs 50.9 %; p < 0.01), suggesting early case detection. However, there was no reduction in subsequent disease among individuals actively screened versus those not screened (1.3 % vs 1.7 %; p = 0.88). Drug use during the year (AHR 3.22; 95 % CI 1.05-9.89) and knows somebody with TB were (AHR 2.86; 95 % CI 1.01-8.10) associated with active TB during one year of follow up CONCLUSIONS: Mass screening in twelve Brazilian prisons did not reduce risk of subsequent disease in twelve Brazilian prisons, likely due to an extremely high force of infection. New approaches are needed to control TB in this high-transmission setting.

journal_name

BMC Infect Dis

journal_title

BMC infectious diseases

authors

Paião DS,Lemos EF,Carbone AD,Sgarbi RV,Junior AL,da Silva FM,Brandão LM,Dos Santos LS,Martins VS,Simionatto S,Motta-Castro AR,Pompílio MA,Urrego J,Ko AI,Andrews JR,Croda J

doi

10.1186/s12879-016-1868-5

subject

Has Abstract

pub_date

2016-10-03 00:00:00

pages

533

issue

issn

1471-2334

pii

10.1186/s12879-016-1868-5

journal_volume

pub_type

杂志文章

在线工具

Impact of mass-screening on tuberculosis incidence in a prospective cohort of Brazilian prisoners.